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Home My WebLink About144 Elk Range Dr - 239127203003 - 0042ENVIRONMENTAL HEALTH P.O. BOX 811 PERMIT NO. EAGLE, COLORADO 81631 APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT Name of Owner: �� 1711-Ile 16 r, Address of. Owner: 4, PERMIT FEE $25.00 1-7 Is facility within boundaries of a city/town or sanitation district? D Distance to nearest sewer system: �� r Location of Proposed System: / j Legal Discription: °� `Y�� f o t /l7 / Type of Structure: Single Family Dwelling (x) Other: No. Bedrooms Water Supply: Private /Well ( ) Location: Distance From leach field: Size of Lot: > 2 111.� Public Water Supply: A! I, �? An appropriate plat plan must accompany site inspection for this application showing required information. (See attached sheet.) The individual sewage disposal system will be constructed and installed in accordance with the regulations governing individual sewage systems within Eagle County, and shall comply with House Bill 1553 CRS 66-14, 1973. Payment shall be made to the Eagle County Treasurer. Permit, upon approval of this application, may be obtained at the Eagle County sanitarian's office. Appointment for final inspection must be made prior to construction by contacting the inspecting sanitarian. [Phone 328-7718 between 8:30 and 9.00 AM.] Refer to permit number. No approval will be given on any system without final inspection: Name, address, and telephone of person responsible for design of system: g k"O. The undersigned acknowledges that the above information is true and that false information will invalidate the application or subsequent permit. SIGNATURE OF APPLICANT: Date: (This a 1cation becomes invalid 6 months from above date.) HEALTH DEPARTMENT USE ONLY Percolation Information: Permit No. Tank Capacity: _? gal. (minimum),,:.: Fee Receipt: � iC%� � S Absorption Area: �� Sq. ft. (minimum) File: t- REMARKS: APPLICATION IS: APPROVED (L/r f DENIED The above individual sewage disposal system was installed by AND HAS BEEN INSPECTED AND APPROVED BY A REPRESENTATIVE OF THE EAGLE COUNTY HEALTH DEPT. Date: Sanitarian:. a OLE PE IrIOLTITION TEST ZiND SITE IN; PECTION FETE 50 .00 PLC' iIT NO. 0,'•7I' E ;: A"'w �E;r /T y Street Address or Legal Description: 42� TY`jn of t,_lr,?elliIlt; T U7-11ber Of DO NOT Td21TE BELO7; THIS LINE Date of Test: �7 Depth of hole: Diameter: Type of soil: Location of Test Hole: Test hole was presoaked from: To: (Time) (Date) (Time) Date: TT „T -.z ; P^ti INCHES OF F I,F,2ATT 3 1 2 3 2-0 sy 3.'00 J D Z©% �3 Percolation Pate: PT Site has been revievTed and test for percolation rate. Te recony:iend: Ai'? :OVAL (- DISAPPOVAI ( ) Date: NOTE: Plot plan showing boundary lines, location of proposed building or buildings and design of septic system must be submitted with Application for Permit to Construct. The back of this form may be used to show plot plan and design of system. By: Sanitarian P. 0. Box 811 Telephone (303) 328-7718 Eagle, Colorado 81631 e 0042- Lot 12 Red Table Acres �^ 0144 Elk Range Drive Melby JOB NO. OB LOCATION BILL TO DATE STARTED DATE COMPLETED DATE BILLED JOB COST SUMMARY PERMIT # 42 OWNER: Ken Melby LOCATION: Lot 12 - Red Table Acres (one acre) C7 L- INSTALLER: Owner SIZE OF TANK: 750 gallons DWELLING: Single family - 2 bedrooms x 300 sq. ft. = 600 sq.ft. PERC RATE: one inch/30 minutes (600 sq. ft.) ( suggest a minimum of 600 sq. ft. of leach field) Finalized: 10-23-75 BY:- Les Douglas --- .. , TOTAL SELLING PRICE TOTAL MATERIAL TOTAL LABOR INSURANCE SALES TAX I MISC. COSTS j i TOTAL JOB COST GROSS PROFIT LESS OVERHEAD COSTS /o OF SELLING PRICE NET PROFIT JOB FOLDER Product 277 �® NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MASS. 01471 JOB FOLDER Printed in U.S.A.